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Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs
1Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle 98195.
Insights
High healthcare utilizers often experience distress, with over half showing symptoms of anxiety, depression, or somatization. Psychiatric consultation improved diagnosis and treatment planning for these patients.
Area of Science:
- Psychiatry and Mental Health
- Healthcare Utilization Research
- Primary Care Medicine
Background:
- A significant portion of high healthcare utilizers exhibit psychological distress, indicated by elevated scores on anxiety, depression, and somatization scales or physician identification.
- These distressed individuals frequently present with chronic medical conditions and limitations in daily activities, contributing to their high healthcare demands.
- High utilizers make numerous annual medical visits and clinic calls, underscoring the need for effective interventions.
Purpose of the Study:
- To investigate the prevalence of psychological distress among high healthcare utilizers.
- To identify common psychiatric disorders within this population.
- To evaluate the effectiveness of psychiatric consultation in improving diagnostic assessment and treatment plans for distressed high utilizers.
Main Methods:
- A sample of 767 high healthcare utilizers was screened for distress.
- 119 distressed high utilizers were randomly assigned to a psychiatric consultation intervention group within a controlled trial.
- The Diagnostic Interview Schedule (DIS) was used to assess psychiatric disorders, including major depression, dysthymic disorder, generalized anxiety disorder, and somatization disorder.
Main Results:
- 51% of high utilizers were identified as distressed.
- Commonly diagnosed disorders included major depression (23.5%), generalized anxiety disorder (21.8%), and somatization disorder (20.2%). Two-thirds had a lifetime history of major depression.
- Psychiatric consultation led to improved diagnostic assessment in 40% of patients and a revised treatment plan in 67%.
Conclusions:
- Psychiatric consultation is a valuable tool for improving the care of distressed high healthcare utilizers.
- Addressing psychological distress in high utilizers can lead to better diagnostic accuracy and more effective treatment strategies.
- Integrating mental health services into primary care settings may optimize care for patients with complex medical and psychological needs.
Abstract:
Among a sample of 767 high utilizers of health care, 51% were identified as distressed by an elevated score on the SCL anxiety and depression scales, the SCL somatization scale, or by their primary-care physician. These distressed high utilizers were found to have a high prevalence of chronic medical problems and significant limitation of activities caused by illness. In the prior year, they made an average of 15 medical visits and 15 telephone calls to the clinic. The Diagnostic Interview Schedule was completed on 119 distressed high utilizers randomly assigned to an intervention group in a controlled trial of psychiatric consultation. The following DSM-III-R disorders were most common: major depression 23.5%, dysthymic disorder 16.8%, generalized anxiety disorder 21.8%, and somatization disorder 20.2%. Two thirds had a lifetime history of major depression. The examination resulted in an improved diagnostic assessment for 40% of intervention patients and a revised treatment plan for 67%.